The pituitary gland/hypophysis is in the Sella turcica/pituitary fossa which is a part of the sphenoid bone and forms the cranial fossa. The gland is divided into the posterior and the anterior pituitary. The most common cause of these disorders is pituitary tumors which are mostly benign (Adenomas) in nature. Diagnosis in most cases is made with MRI, CT imaging and laboratory work-ups. Treatment approaches for pituitary gland disorders involve various methods including medication and surgery. Prognosis depends on the diagnosis.

00:02
Differences between apoplexy and Sheehan.
00:04
What’s apoplexy?I told you that the-the pathogenesis that
it shares with would be more or less withmassive haemorrhage into the adrenals.
00:13
That’s Waterhouse–Friderichsen, completely
different.
00:16
But, this is acute haemorrhage into the pituitary
tumour resulting in what?Good.
00:21
Pituitary insufficiency.
00:22
There will be sudden headache because now,
literally, sella’s filling up with bloodso very quickly.
00:27
It’s going to be a sudden headache and the
fact that the optic chiasm is been affectedor compromised resulting in bitemporal hemianopsia.
00:36
It might also have issues with cranial nerves
III oculomotor, trochlear 4 and then maybesomething like your 6 abducens, meaning to
say you’re going to have visual issues.
00:48
With this sudden rush of blood into your sella,
this is not about you going in there and removinga tumour.
00:57
This is about you relieving that pressure
ASAP.
01:01
Once again, when this is taking place, what’s
the most important hormone that you’re alwayspaying attention to?It’s the cortisol, cortisol, cortisol.
01:08
In addition, understand that the pituitary…Do not, I mean, when there’s talk about
insufficiency, do not just restrict yourselfto the anterior pituitary.
01:17
Your patient might not have ADH, may result
in symptoms of what?Central diabetes insipidus.
01:22
Are we clear?Are we clear?Most dangerous of them all would be your secondary
adrenal insufficiency due to lack of ACTH.
01:30
So, what’s your treatment?Please make sure that you treat your patient,
manage, manage, manage.
01:36
Glucocorticoid, glucocorticoid, glucocorticoid.
01:38
I cannot stress that enough.
01:40
There will be certain interesting topics that
we’ll walk through there.
01:45
When we start talking about the most common
cause of Cushing in the United States is iatrogenic,isn’t it?Exogenous, factitious, all the same thing.
01:59
And we’ll talk about a very important scenario
in which you really want to make sure thatyou’re very clear about how the adrenals
would die and how a patient with Cushing isgoing to present.
02:17
And I would try to reinforce that over and
over again and I will make sure that I dothat for you.
02:24
Listen.
02:25
If you take prednisone, cortisol, you can
call it cortisol, then you’re going to looklike Cushing.
02:33
When you take cortisol, who’s being supressed?The body is fooled.
02:42
The ACTH will be supressed and the adrenals
undergo atrophy.
02:47
Isn’t that interesting?So, the patient looks like Cushing in the
US, right?Exogenous.
02:57
Internally, what’s going on with your patient?Secondary hypocortisolism.
03:03
Isn’t that fascinating?Make sure that you’re clear with that.
03:07
If you’re not, that’s okay, I’ll keep
repeating, like I have been doing it witheverything else.
03:11
By the time it becomes… by the time we’re
done, it will be part of your subconsciousreflex.
03:16
You want to make sure with this apoplexy that
you immediately relieve the pressure.
03:22
Decompression surgically.
03:24
It’s an urgency.
03:27
Versus Sheehan.
03:28
In Sheehan, we talked about the pregnant woman
who is-who is having massive haemorrhage andduring that haemorrhage, there’s going to
be pretty massive pituitary infarction.
03:39
This is called Sheehan.
03:40
She’s going to then present with lack of
the ability to lactate and breastfeed herchild.
03:47
And as far as management is concerned, you
want to make sure that she’s able to properlysurvive with her stress hormone called?Cortisol, good.
03:58
Pituitary insufficiency.
04:01
Apoplexy versus Sheehan.
04:03
This is Sheehan.

About the Lecture

The lecture Pituitary Apoplexy and Sheehan’s Syndrome by Carlo Raj, MD is from the course Pituitary Gland Disorders.

Included Quiz Questions

Pituitary apoplexy presents with all EXCEPT which of the following symptoms?

Lack of dopamine production

Sudden headache

Ophthalmoplegia

Altered mental status

Adrenal insufficiency

What causes adrenal insufficiency in a patient with pituitary apoplexy?

Decreased ACTH

Iatrogenic cortisol injection

Increased cortisol

Cushing's disease

Decreased dopamine

Classic presentation of Sheehan's syndrome includes which of the following?

New mother who cannot produce milk

Adrenal insufficiency

Cushing's syndrome

Altered mental status

Ophthalmoplegia

Author of lecture Pituitary Apoplexy and Sheehan’s Syndrome

Carlo Raj, MD

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